title: Screening for acromegaly by application of a simple questionnaire evaluating the enlargement of extremities in adult patients seen at primary health care units.
abstract: The objective of this study was to screen for acromegaly by application of a simple questionnaire in patients seen at primary health care units. A total of 17,000 patients of both genders >18 and <70 years seen by general practitioner were interviewed. Patients with known pituitary disease and pregnant women were excluded. A simple questionnaire was applied to the patients: Has your shoe size increased over the last 5 years? Did you have to change your wedding ring or ring over the last 5 years because it became tight? In one patient, the diagnosis of acromegaly was suspected by the physician. Among the remaining patients, 178 (1%) responded positively to one of the items of the questionnaire and were submitted to IGF-1 measurement. Five patients had persistently elevated IGF-1 and inadequate suppression of GH in the OGTT (without other conditions associated with GH or IGF-1 elevation). One of these patients presented a normal pituitary upon magnetic resonance imaging and adenoma was detected in the other four; two presented the typical facies and two others reported changes in physiognomy (confirmed by the comparison of photographs), in addition to the enlargement of extremities. The present investigation suggests a much higher prevalence of acromegaly in the adult population than that reported traditionally. We propose that screening based on phenotypic alterations is cost-effective since these changes occur early and almost universally in acromegaly and are uncommon in the general population.
authors.affiliation: Postgraduation Program, Santa Casa de Belo Horizonte, Av Francisco Sales 1111, 9ºD, Santa Efigênia, CEP 30150-221, Belo Horizonte, Minas Gerais, Brazil. pedrorosario@globo.com
authors.forename: Pedro Weslley
authors.initials: PW
authors.lastname: Rosario
authors.forename: Maria Regina
authors.initials: MR
authors.lastname: Calsolari
mesh_terms: D000172:Acromegaly / Q000175:diagnosis*; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D011320:Primary Health Care; D011795:Surveys and Questionnaires; D055815:Young Adult